As an IVF specialist , I have noticed that infertile men often get very poor quality treatment. There are many of reasons for this.

The first is the infertile couple themselves. Having a baby is usually considered to be the woman’s problem , and she is the one who seeks medical attention which means she usually goes to her gynecologist. Many men have a fragile ego, and while some refuse to go for sperm testing , others postpone this, because they are worried they will find that they have a problem. Many men still blissfully resume that if their libido is normal , this automatically means that their fertility is fine , and that they do not need to check their sperm count.

By default, it is usually the gynecologist who then becomes the primary care physician for infertile couples. Unfortunately, most gynecologists are clueless about male infertility. Many have never examined a man in their entire professional career . They usually ask for a semen analysis; and if this is abnormal, they refer the man to a urologist. However , sometimes they do not interpret the semen analysis report properly , and this causes its own set of problems. For example some gynecologists still believe that a count of less than 60 million is abnormal – which means that men with a completely normal semen report are overtreated with medication , wasting valuable time.

What happens when the infertile man is referred to the urologist ? While the urologist is a specialist , many of them do not have a special interest in treating the infertile man; and there are very few specialised andrologists ( male infertility specialists). This is why many urologists continue to provide many ineffective tests and treatments for the infertile man. They will often try empiric medical therapy to improve a low sperm count; and because this rarely works, patients get fed up and frustrated. The trigger happy urologists diagnose a varicocele for practically all men referred to them, by doing a color Doppler ultrasound scan. Once they find a varicocele , they are happy to treat it – and when this doesn’t help to improve the patient’s fertility status, they throw up their hands and say – Sorry – there is nothing else we can do ! The other problem with a referral to a urologist is that the care of the infertile couple gets fragmented. Often the gynecologist has no idea what the urologist is doing , and vice versa, which means the couple is not treated as a unit. This often causes them to lose confidence in medical treatment.

Another weak link in the medical system is the fact that many laboratories do not know how to perform a semen analysis properly. Since it is such a cheap test, they often do it badly, resulting in wrong reports – and therefore , the wrong treatment.
Compounding this problem is the underlying fact that the basic sciences understand very little about male infertility. We really still don’t know enough about normal sperm production; and since we cannot pinpoint what the problem in sperm production is in the infertile man , there is very little effective treatment we can offer him. This is why the standard treatment for a man with a low sperm count today is ICSI ( intracytoplasmic sperm injection, www.drmalpani.com/icsi.htm) – a treatment which is conceptually crude, but works amazingly efficiently. We still do not have good tests for analyzing sperm function, so that a lot of our treatment consists of bypassing problems , rather than identifying them and solving them. This is a sad testimony to the fact that the infertile man has been relatively
neglected !

About 15 years ago , it was felt that strict morphology testing using Kruger criteria would help us to identify which infertile men had functionally competent sperm. Unfortunately , we now realize that these criteria are not always reliable. The new generation of sperm function tests are supposed to check for DNA integrity. Unfortunately , these are equally unreliable, even though they are presently very fashionable. This is because while they do generate valuable information in research studies, they are not very good at providing clinically useful information for the individual patient. Thus , while we know in general that infertile men will have higher sperm DNA fragmentation levels than fertile men, there is no number at which we can tell the infertile man whether or not his sperm are capable of fertilizing his wife’s eggs.

This sad truth is that male infertility treatment still leaves a lot to be desired. And this is why , ironically , the most effective treatment for the infertile man it to treat his fertile partner !

This is a guest blog entry from the mother of one my patients. It offers great insight into the impact of infertility on other family members !

Q 1 What do you feel when you see your daughter go through IVF ?

A There are mixed feelings – of high hopes as well as anxiety. On a positive note, I feel good that with the advances in medicine today we have expert guidance in Infertility Treatment which was not available to the previous generation. So, a ray of hope crosses my heart that there is still a chance for my daughter to conceive and achieve her dream.

Anxiety, that my daughter has to take so many injections and medicines. I can see her emotional strains when two IUI cycles failed after all the efforts put in not to mention the financial loss incurred due to her taking leave without pay from her current company to attempt IVF as also the risk that she may not get her job back.

However, the biggest risk – “What if too much of these injections and medicines end up in pregnancy, but with a child suffering from Down’s Syndrome? Better not to have a child than give birth to one who will face difficulties for life.

Q 2 How does your daughter cope? How does she feel about it?

A I can see my daughter struggling to cope with difficulties and there are quite a few – the main being to reduce her weight.

I admire her commitment to have gone through it all. She could have chosen the easy way out and said ‘No’ to Infertility Treatment. After all, she has crossed 40 yrs. and she knows her chances are low. She has sacrificed her job, left her home in Pune to be under Dr. Malpani’s excellent care in Mumbai.
As a mother, I’ve encouraged her to do her Best and leave unto God the Rest.

It is said that some of our principal regrets in life are the opportunities we passed up and the chances we didn’t take.

Q 3 How do I feel about one child having children, one not?

A Each person has his own Destiny – Karma. My daughter got married at 41 yrs, while my son was quite young when he married , so by God’s grace he did not have difficulty vis-à-vis “infertility factor”.

According to me, the be all and end all of marriage is not just re-production. Sure, grand children are a source of delight and posterity is ensured.
However, I’d rather apply the analogy to marriage that “Oftentimes two people working together find easy that which seems un-surmountable to one alone.”

Dr. Aniruddha Malpani is one of the best Infertility Specialists in India. He completed his MBBS from Seth GS Medical College, Bombay, in 1982. He took his DGO and MD degrees from Bombay University. He passed his D.N.B. appearing for the National Board of Examinations. Dr. Malpani has been the recipient of a glittering array of prizes, awards and scholarships through his academic years.

Currently, he and his wife Dr. Anjali Malpani, both infertility specialists, are in private practice.

Dr. Aniruddha and Dr. Anjali Malpani have started India’s first Sperm Bank in Bombay, for therapeutic insemination by using donor cryopreserved sperm The Bank has a full-fledged infertility unit, which provides comprehensive services, including IVF, GIFT and micromanipulation. The doctors have achieved the first pregnancy in India using the sophisticated technique of PGD (preimplantation genetic diagnosis), which allows a screening of embryos for genetic abnormalities. They have also started India’s first support group for infertile couples, a registered charitable trust, called Infertility Friends.

Dr. Malpani believes in empowering the public with health awareness, as a means of promoting its health, and helping itself prevent and treat ailments in partnership with doctors. He has founded the Health Education Library for People, India’s first Consumer Health Education Resource Centre with reading, browsing and other library facilities. It has a collection of books, magazines, journals, CD ROMs, and videotapes covering all aspects of health explained in terms, which the lay person can understand.

Dr. Aniruddha has, with Dr. Anjali Malpani, authored two books: Getting Pregnant – a Guide for the Infertile Couple, and Best Medical Care – A Guide for the Intelligent Patient. He has published articles in several national and international journals. Memberships: He is a member of the European Society for Human Reproduction and Embryology, Brussels, Belgium.